Setting Scope of Practice
States are responsible for setting licensure requirements for health professions, but formal licensure processes vary greatly across direct care workforce positions and settings. The scope of practice for direct care workers varies greatly from state to state-in part due to the diversity of practice settings and various training models required.
CNAs may assist patients with activities of daily living and perform certain clinical tasks as delegated and supervised by another onsite licensed professional. Acceptable tasks may include basic nursing skills, infection control, basic restorative care (such as rehabilitation activities following injury) and addressing a patient's mental health and social service needs.
Home health aides are generally supervised by a registered nurse but may be supervised by another licensed provider as well. In addition to activities of daily living, home health aides may:
- Perform simple procedures as an extension of therapy or nursing services such as blood pressure reading, infection prevention and wound care.
- Assist in movement or range-of-motion exercises.
- Assist in administering medications that are ordinarily self-administered such as reminding a patient to take their medication, bringing them fluid or opening a bottle.
Personal care aides may provide activities of daily living as well as tasks such as household maintenance, chores, meal preparation and medication management. Their scope of practice does not include basic nursing or medical activities, and supervision of these tasks by a nurse or other health care provider is not usually required.
With additional training or certification, CNAs, home health aides and personal care aides may also administer medications in some states. Idaho requires unlicensed assistive professionals who are supervised by licensed nurses to complete a board-approved training program to assist patients who cannot independently administer their medication. New Hampshire authorizes certified assistant living medication aides to administer medications in certain residential settings and establishes a loan repayment program for nursing professionals. New York established a new profession, the Advanced Home Health Aide. These are home health aides who are trained to provide advanced tasks under the delegation and supervision of registered nurses, including administering routine medications. Tennessee allows a nurse to delegate authority to administer certain medications.